■使用外固定器进行肢体重建需要适当的疼痛管理,以促进有效的镇痛和愈合,同时将所用镇痛技术的不良事件降至最低。本前瞻性病例系列的目的是评估旨在减少阿片类药物需求并因此减少阿片类药物相关副作用的多模式镇痛方案。
■接受下肢重建手术(LRS)的前瞻性队列患者通过循证多模式镇痛指南(MMAG)进行管理,包括对乙酰氨基酚,普瑞巴林,右美托咪定,利多卡因静脉注射,和阿片类药物。结果指标包括术中和术后阿片类药物给药,术后疼痛评分,达到动员里程碑的时间,和术后并发症。进行调查以获得患者报告的经验。
■26例患者纳入本前瞻性病例系列。110.59(84.29,162.13)(中位数,四分位距)µg/kg/hr术中静脉给予吗啡等效阿片类药物。在术后的最初48小时内,患者接受了11.49(6.41,19.35)µg/kg/hr的静脉注射吗啡等效剂量.术后前48小时的疼痛中位数(0-10)为2(1,2)。患者实现了动员。接受调查的19/20名患者报告说有有效的疼痛管理;17/20名患者没有与镇痛药物相关的不良副作用。没有筋膜室综合征的病例。
■这种多模式镇痛方案应用于使用外固定器接受较低LRS的患者,证明了这种镇痛方案的可行性,显示了有效的疼痛控制,早期动员,副作用最小,但值得进一步研究。
■这项研究提供了有价值的证据,证明这种标准化的多模式麻醉和镇痛方案是可行的,在我们机构的儿科LRS人群中,提供足够的术后舒适度并鼓励早期动员,同时最大程度地减少阿片类药物的使用和不良事件。
■WangAWT,ChhinaH,CooperA.使用外固定器进行下肢重建的儿科患者的多模式镇痛:术后疼痛和功能目标的前瞻性病例系列。策略创伤肢体重建2023;18(3):140-147。
UNASSIGNED: Limb reconstruction with external fixators requires appropriate pain management to promote effective analgesia and healing while minimising adverse events of the analgesic technique used. The objective of this prospective
case series was to evaluate a multimodal analgesia regimen designed to reduce opioid requirements and hence reduce the opioid-related side effect profile.
UNASSIGNED: A prospective cohort of patients undergoing lower limb reconstruction surgery (LRS) were managed through an evidence-informed multimodal analgesia guideline (MMAG), including acetaminophen, pregabalin, dexmedetomidine, IV lidocaine, and opioids. Outcome measures included intraoperative and post-operative opioid administration, post-operative pain scores, time to achieve mobilisation milestones, and post-operative complications. Surveys were conducted to obtain patient reported experiences.
UNASSIGNED: 26 patients were included in this prospective
case series. 110.59 (84.29, 162.13) (median, interquartile range) µg/kg/hr intraoperative IV morphine equivalent opioids were administered. In the first 48 hours post-operatively, patients received 11.49 (6.41, 19.35) µg/kg/hr of IV morphine equivalent dose. Median level of pain (0-10) in the first 48 post-operative hours was 2 (1, 2). Patients achieved mobilisation. And 19/20 patients surveyed reported \'yes\' to having effective pain management; 17/20 patients had no unwanted side effects associated with analgesia medications. There were no cases of compartment syndrome.
UNASSIGNED: This multimodal analgesia regime applied to patients undergoing lower LRS with external fixators demonstrates the feasibility of this analgesic regimen which revealed effective pain control, early mobilisation, with minimal side effects, but warrants further study.
UNASSIGNED: This study provides valuable evidence that this standardised multimodal anaesthesia and analgesia regimen is feasible, offers adequate post-operative comfort and encourages early mobilization while minimising opioid use and adverse events in a paediatric LRS population at our institution.
UNASSIGNED: Wang AWT, Chhina H, Cooper A. Multimodal Analgesia for Paediatric Patients Undergoing Lower Limb Reconstruction with External Fixators: A Prospective
Case Series of Post-operative Pain and Functional Goals. Strategies Trauma Limb Reconstr 2023;18(3):140-147.